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Times features lean transformation at Seattle Children’s, debate ensues

July 12, 2010

Seattle Children’s Hospital and Medical Center is one of a growing number of local providers making a long-term commitment to lean and reaping the benefits, a success story highlighed Sunday in The New York Times.  Along with Virginia Mason and Group Health, Seattle Children’s draws a steady stream of visitors to Seattle to see how lean can be successfully implemented in a healthcare setting.

Of course, one of the pitfalls of being featured in a general circulation newspaper, even one as venerable as the Times, is the appearance of the inevitable “two sides to every story” subplot.  I think we’re all familiar with the rule that journalists are required to solicit counterarguments from those who might be critical.  In this case, the Times sought to balance the roundly positive results enjoyed at Children’s by interviewing Nellie Munn of the Minnesota Nurses Association.  As reported by the Times,

On June 10, Ms. Munn helped lead a one-day strike by the Minnesota Nurses Association against six local health care corporations, including her employer, partly in protest of lower staffing levels her union thinks have resulted from hospitals’ “lean” methods.

Journalists can’t be experts in every subject (although beat reporters make a reasonable effort).  So, to avoid unduly favoring one viewpoint over another, they report two sides and let the reader decide. 

Balance makes complete sense until you try to apply it to your own line of work.  For example, if you are a CFO, you can’t walk into the CEO’s office and say, “Well, according to prevailing opinion, you made a profit.  However, there is an increasingly vocal faction within the organization who believe that you, in fact, took a loss.  I’m simply reporting both sides of the story.  You’re free to decide the company’s financial stability for yourself.”

You can say I’m biased but, contrary to a vocal faction within the Minnesota Nurses Association, evidence shows lean improves patient safety.  Done right, the benefits of lean accrue not just to the patient, but also to the individuals caring for the patient and the hospital’s bottom line, generally in that order.  Of course, lean is difficult, it takes time to master, and it doesn’t always show results right away.

The two pillars of lean are continuous improvement and respect for people.  However, there are aspects of lean that can ring alarm bells among employees who do not yet have a wholistic appreciation for lean.  The first is standardized work.   In lean, first you standardize, then you improve.  Improving a non-standard process is like remodeling a house built on quicksand.  It won’t do you much good in the long run.

Unfortunately, there is a long history in America, from the early work of Fredrick Taylor to today, of managers and consultants hovering above employees with stopwatches seeking to cut costs by eliminating jobs.  You can say lean is collaborative.  You can say no employee will be laid off as a result of lean improvements.  But the weight of history sometimes prevails and the only way to prove lean is different is to see results over the course of several years.  In the meantime, critics of lean will have ample fodder.  For a sample of how this conversation can unfold, read Mark Graban’s online discussion with an anonymous supporter of the Minnesota Nurses Association.  [Full disclosure: My mom is a practicing nurse and member of a nurses union at a hospital that unsuccessfully attempted to implement lean practices.]

Mr. Graban, one of the leading voices in lean healthcare, exercised laudable restraint in his responses.  In fact, it must have felt a tiny bit awkward being party to a “lean vs. union” debate, since lean production systems operate with the full blessing and support of union leadership and membership in a wide range of workplaces, from hosptials to automobile plants.  Children’s of Minnesota, the object of the Minnesota Nurses Association’s misplaced suspicion, is a mission-driven not-for-profit organization.  While no organization is immune to bad decision-making, the argument that Children’s of Minnesota is knowingly endangering patients to make a quick buck falls flat.

The second aspect of lean that can ring alarm bells is its association with Toyota.  Indeed, lean’s greatest champion can sometimes be its greatest Achilles heel.  Isn’t lean the system invented by Toyota? critics may ask.  Why would anyone want to send an uncontrollably accelerating Prius careening down the corridors of a hospital?

Again, there’s no equally visceral counter-argument.  Lean is a mostly scientific process, driven by front-line care providers based on evidence.  One can respond with evidence but, as we see in arguments over climate change or evolution, evidence is not always the primary medium of exchange in certain debates.  Instead, we hear that caring for sick people is not the same as building automobiles.  And it’s true.  In fact, automobiles in a Toyota factory receive more attention to quality than patients in a hospital, not less.  If reducing medical mistakes means learning from a car company, then learn we should.

4 Comments leave one →
  1. July 13, 2010 5:41 am

    Nice post and thanks for the link. The MN Nurses’ Union really seems more interested in talking about the hospital CEO’s paychecks than Lean. There’s a deep-seated resentment against business and profit that blurs their thinking (or they feel the need to attack lean to further their union agenda). None of those things are particularly patient-centered, it seems (of course, many hospital CEO actions aren’t patient-centered either, to be fair).

  2. Michelle permalink
    July 15, 2010 12:18 am

    Found your link on the MNA blog page too.
    Unfortunately LEAN improves patient care without needing to implement the stringent nurse:patient ratios that the unions (NNU and MNA) are so rabidly promoting.
    I look forward to learning more about the Lean process’ and seeing them implemented in our hospitals.

  3. July 15, 2010 10:44 am

    Thanks, Michelle. I saw your comment on the MNA site. Curious to see if/how they respond to you. Thanks for posting that.

  4. November 10, 2010 7:02 pm

    Since I was prompted to look at this anew, I’d like to elaborate on my thoughts.

    I’m not “anti-union.” My observation on the MN Nurses Association video was that the “anti-Lean” video was done in the context of VERY contentious labor negotiations (and sometimes extreme positions get taken) and the video spent such a great deal of time talking about CEO pay, it certainly seemed what I’d call anti-business and a bit of class warfare.

    Lean is about respect for all parties involved – I guess the question of “excessive CEO pay” comes into account here since Japanese companies (which aren’t all lean) have CEO pay at a lower multiple than the typical American company.

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